Following the Barcelona staging system of hepatocellular carcinoma in 5 stages, palliative medical treatment have to be given to end-stage patients (best supportive care) and to advanced and intermediate stages. Chemoembolization is the standard of care for intermediate stages; results depend on the baseline parameters and for the best patients are close to those of surgical resection. By contrast, for more severe patients the prognosis and the tolerance of chemoembolization are poor; for such patients sorafenib can be a good option. The results of radioembolization are close to those of chemoembolization, with a better tolerance. Sorafenib is now the standard of care of advanced stages patients wth well compensated liver cirrhosis and good performance status. No second-line option is currently validated. To summarize, these improvements in palliative treatment for hepatocellular carcinoma need to present most cases to a multidisciplinary team discussion.