Percutaneous injection of ethanol for treatment of hepatic tumors was first described by Sugiura et al. [1] in 1983. To date, reported experience with the procedure has focused mainly on therapy of hepatocellular carcinoma (HCC) [2-15], with little information available regarding its use in treating metastatic liver lesions [16]. Interest in this technique has grown recently as a possible means of treating patients with metastatic liver disease. The purpose of this perspective is to review the indications, mechanism of action, technique, complications, and efficacy of percutaneous ethanol injection for liver tumor treatment.