The choice of treatment for primary liver cancer should be based on the size and number of tumors, the location and extent of tumor invasion, the presence or absence of venous cancer embolism, distant metastasis, the degree of liver function compensation and the patient’s general condition. However, due to the insidious symptoms of primary liver cancer, about 70% of patients have lost the opportunity of surgical resection or cannot tolerate surgery at the time of clinical diagnosis, therefore, non-surgical treatment methods also play an important role in the treatment of primary liver cancer. Non-surgical treatments for primary liver cancer include transcatheter arterial embolization chemotherapy, percutaneous ablation therapy, radiation therapy, chemotherapy and biologic therapy, etc. The progress of non-surgical treatments for primary liver cancer is reviewed here. Transcatheter arterial embolization chemotherapy (TACE) is the most commonly used non-curative treatment to improve the survival rate of patients. It is suitable for patients without surgical indications who develop extrahepatic tumor metastasis, and it can also serve as a discriminatory diagnosis for patients who cannot determine the extent of the lesion.Contraindications to TACE include advanced liver disease without portal venous flow or low blood flow, and advanced liver disease that may trigger liver failure. Early hepatocellular carcinoma is mainly supplied by the portal vein, and as the tumor increases in size, the blood supply to the tumor gradually comes from the hepatic artery. This phenomenon is not only the imaging basis for the diagnosis of HCC, but also the theoretical basis for hepatic artery embolization of mid-stage tumors during TACE treatment. When performing hepatic artery chemoembolization, the chemotherapeutic drug is mixed with iodine oil and then injected into the small artery branch that directly supplies blood to the tumor, and subsequently embolized and blocked that supply artery. The commonly used embolic substance is gelatin sponge, but polyvinyl alcohol, starch microspheres and metal spiral rings can also be applied J. The ultra-microcatheter technique developed in recent years can achieve hepatic segment or subhepatic segment embolization, which can achieve both complete embolization and maximum protection of liver function, and therefore obtain satisfactory therapeutic results. However, for large hepatocellular carcinoma, even with multiple chemoembolizations, complete embolization is still difficult to be achieved, so other local treatments, such as intra-tumor injection of anhydrous ethanol and radiofrequency ablation therapy, can be used to assess tumor necrosis based on enhanced CT or MRI findings and to achieve maximum tumor necrosis. Takayasu et al. analyzed 8510 patients with inoperable primary hepatocellular carcinoma in Japan, and the median survival time for patients undergoing TACE was approximately 34 months, with patient survival rates of 82%, 47%, 26%, and 16% at 1, 3, 5, and 7 years, respectively. Even in patients with portal vein thrombosis, treatment with appropriate TACE can extend the mean survival time to 9.5 months, with a 1-year survival rate of 25%. When performing TACE, the dose of chemotherapeutic drugs should be appropriately reduced for patients with hematocrit and embolization should be the main treatment; for patients with combined arteriovenous fistula, perfusion chemotherapy should be the main treatment. Chung et al. observed 1,629 transcatheter arterial embolizations in 479 patients and found that 17% of the lesions had extrahepatic vascular blood supply, which affected the effect of TAE. However, Marelli et al. found in a randomized controlled study that there was no significant difference in the effect of embolization alone compared with embolization plus chemotherapy on patient survival, and there was no significant correlation between the application of different chemotherapeutic agents and patient survival. It can be used for patients with single HCC <5 cm in diameter or HCC with ≤3 tumors and individual tumors <3 cm in diameter. For tumors <2 cm in diameter, the tumor recurrence and survival rates after successful ablation are comparable to those after surgical resection. Usually, percutaneous ablation therapy involves the injection of chemicals into the tumor under ultrasound guidance, or extreme temperatures can be used to destroy the tumor. 3.Radiotherapy According to the patient's condition, reasonable application of radiotherapy techniques to obtain higher radiation dose for liver tumor is the main idea of radiotherapy for primary liver cancer. Since the tolerated dose of radiotherapy for hepatocytes is lower than the radical dose for hepatocellular carcinoma cells, the application of conventional radiotherapy in the treatment of primary hepatocellular carcinoma will not be able to balance the tumor control rate and the complication rate of normal tissues, so radical radiotherapy should not be carried out. Radiotherapy can be applied to the palliative treatment of inoperable giant primary liver cancer and advanced primary liver cancer or combined with other treatment methods. Radiotherapy has a certain palliative effect on larger tumors or metastases, and can also be used to relieve symptoms for those with more severe disease, such as relieving obstructive jaundice caused by tumors in the hilar region or bile duct compression and pain caused by bone metastases. For primary hepatocellular carcinoma combined with hilar lymph node or abdominal lymph node metastasis, radiotherapy can be applied to the palliative treatment of portal vein cancer thrombosis, inferior vena cava cancer thrombosis, hilar lymph node or abdominal lymph node metastasis and distant metastatic lesions after controlling the primary lesions in the liver. Since the tumor targeting of conventional external radiation therapy techniques is insufficient, liver tissues are difficult to tolerate high doses of radiotherapy, and patients with cirrhosis tolerate radiotherapy even less, the use of 3D conformal radiotherapy technique helps to reduce the dose of radiotherapy to normal liver tissues while safely increasing the dose of radiotherapy to tumor target areas, with the total dose of radiotherapy increasing up to 90 Gv depending on the size of the normal liver volume receiving radiotherapy. Kim et al. summarized the results of 70 cases of primary liver cancer treated with 3D conformal radiotherapy, the efficiency rate of primary tumor lesions was 54.3%, the efficiency rate of portal vein thrombosis was 39%, and the median survival of radiotherapy patients was extended by 11.2 months. Yin et al. reported that 26 patients with primary liver cancer were given systemic chemotherapy with a quadruple regimen of cisplatin, doxorubicin, fluorouracil and interferon, and the 1-year survival rate was 24.3%, with a median survival of 6 months. The median survival of patients with primary liver cancer who were deprived of surgery was 10.1 months. Another study reported that the application of anti-androgen drugs and octreotide did not achieve significant efficacy . Therefore, exploring new chemotherapy regimens and improving chemotherapy index is the current research direction. 5.Biological therapy In recent years, the application of biological therapy in I clinical has shown desirable effects, and some drugs have become the first-line drugs for the treatment of tumors. In the case of primary liver cancer, biologic therapy is suitable as recurrence prevention treatment after surgical resection of liver cancer or as adjuvant treatment after effective tumor reduction therapy.