Abstract: Objective To evaluate the therapeutic effect of hepatocellular carcinoma (HCC) portal vein tumor thrombus (PVTT) treated by ¹²⁵I particles implantation combined with high intensity focused ultrasound (HIFU) therapy. Methods Nineteen patients with hepatocellular carcinoma portal vein tumor thrombus in different grading who underwent ¹²⁵I particles implantation combined with HIFU therapy in our hospital from March 2011 to October 2013 were enrolled in our study. The ¹²⁵I radioactive dose was 80-120 Gy, single particle radioactive dose was 0.5 mCi; HIFU:the frequency was 0.85 MHz, the total treatment time was 33-70 min, and the irradiation power was at an average of 300-400 w. 1-30 months of follow-up evaluation was made concerning the curative effect and adverse reaction, the tumor emboli size changes before and after treatment, postoperative complications and survival rate of the patients. Results All patients had undergone complete treatment, there was no postoperative bleeding, cancer plug and severe complications such as acute liver failure. After 1 month's review, all tumor embolus shrank to different extent. Following-up was done 1 to 30 months with the survival time of 3-26 months. 1- and 2-year survival rate were 47.4% (n=9) and 21.1% (n=4), and the average survival period was (11.6±3) months, level Ⅰ, Ⅱ, Ⅲ median survival were 13.5, 7, 4 months, respectively. Conclusion The local curative effect of ¹²⁵I implantation combined with high intensity focused ultrasound in treatment of hepatocellular carcinoma with portal vein tumor thrombus is obvious, with small trauma and low complication rate. It is a simple, safe and effective treatment.