The food-processing industry has made large investments in processing facilities relying mostly on conventional thermal processing technologies with well-established reliability and efficacy. Replacing them with one of the novel alternatives recently developed is a decision that must be carefully approached. Among them, high-pressure processing (HPP), at room or refrigerated temperature, is now a wellestablished option experiencing worldwide commercial growth. Surveys have shown an excellent consumer acceptance of HPP technology. For financial feasibility reasons, HPP treatments must be kept short, a challenge that can be met by some of the alternatives here reviewed such as the use of the hurdle technology concept. Although HPP technology is limited to pasteurization treatments, the combination of high pressure and high temperature used in pressureassisted thermal processing (PATP) can be used to sterilize foods. An analysis of alternatives to achieve the inactivation of bacterial spores at the lowest temperature possible highlights the need for additional research on the use of germinants. Because of incomplete research, PATP presents several implementation challenges, including the modeling of food temperature, the determination of inactivation kinetics particularly for bacterial spores, and the prediction of chemical changes including the potential formation of toxic compounds.