BACKGROUND: This study was conducted to evaluate the efficacy and safety of ablative techniques in elderly patients with hepatocellular carcinoma (HCC). METHODS: From February 2004 to February 2009, 80 elderly patients (age > 70 years) affected by non-resectable HCC were treated with a regional palliative approach, trans-arterial-chemo-embolization and radio-frequency-thermal-ablation (TACE, RFA). Our approach includes a first treatment of TACE and then a control CT plan after a month. A possible following RFA can be performed to ensure a complete necrosis of the lesions, and then a further contrast enhanced CT scan after 2 months. For 60 patients, the first TACE was sufficient to treat the disease at beginning. For 15 patients TACE was followed by RFA, and for 5 patients an RFA was performed directly due to nodule localization. Response to TACE is assessed every 2 to 3 months with serial AFP level and TC scan. RESULTS: Two patients died for related method’s causes (2.5%): liver-renal syndrome (1 patients), and portal thrombosis with irreversible postoperative liver failure (1 patients). A total of 15 patients were lost to follow-up (18.7%): 2 (2.5%) patients had died for non-tumor-related causes, 1 due to a liver transplantation, and 12 (15%) due to failure to attend follow-up visits. All patients developed further localisation, medially after 4 months, and underwent TACE treatment for a mean of another two times. A mean follow up is 36.7 months (1-60) with a mean survival rate of 35.1 months (1-60) CONCLUSIONS: We conclude that, even in over 70-year-olds, TACE and RFA treatment should be employed to completely cure HCC, if liver function and tumor stage are acceptable.