Landfilling is nowadays the most common practice of waste management in Italy in spite of enforced regulations aimed at increasing waste pre-sorting as well as energy and material recovery. In this work we analyse selected alternative scenarios aimed at minimizing the unused material fraction to be delivered to the landfill. The methodological framework of the analysis is the life cycle assessment, in a multi-method form developed by our research team. The approach was applied to the case of municipal solid waste (MSW) management in Rome, with a special focus on energy and material balance, including global and local scale airborne emissions. Results, provided in the form of indices and indicators of efficiency, effectiveness and environmental impacts, point out landfill activities as the worst waste management strategy at a global scale. On the other hand, the investigated waste treatments with energy and material recovery allow important benefits of greenhouse gas emission reduction (among others) but are still affected by non-negligible local emissions. Furthermore, waste treatments leading to energy recovery provide an energy output that, in the best case, is able to meet 15% of the Rome electricity consumption.