TACE With or Without Radiation Therapy in Treating Patients With Stage A-C Liver Cancer

Inclusion Criteria:

* HCC is staged as Barcelona A to C
* Treatment with SBRT can occur within 6 weeks of registration
* Eastern Cooperative Oncology Group (ECOG) performance status =\< 2
* Patient has

  * Radiographic enhancing liver lesions with early wash out on triple phase CT or MRI or
  * Histological confirmation of HCC as determined by the Liver Tumor Board
* Hemoglobin greater than 10.0 g/dL
* Total bilirubin less than 3.0 mg/dL
* Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) =\< 3 X institutional upper limit of normal
* Alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 3 X institutional upper limit of normal
* Total aggregate of maximal dimension of liver tumors is =\< 8 cm
* Cirrhotic patients Child Pugh class A or B (score =\< 7)
* Patient must be determined by the treating physician to be medically eligible for liver transplantation measured by imaging modality (magnetic resonance imaging \[MRI\]/computed tomography \[CT\] scan) three months post final treatment
* Absolute neutrophil count \>= 1,500/μl
* Platelet count \>= 50,000 μl (after transfusion if required)
* Life expectancy \> 12 weeks
* Subjects must have the ability to understand and be willing to provide written informed consent
* Women of child-bearing potential must have a negative pregnancy test within 4 weeks to the start of the SBRT treatment
* Women must not be pregnant or nursing
* Sexually active women must agree to use accepted forms of birth control; acceptable options for birth control will be documented in the consent and discussed with the subject prior to enrollment

Exclusion Criteria:

* Patient with previous history of abdominal radiation
* Cirrhotic patients Child Pugh class B with score \>= 8
* Prior invasive malignancy other than primary liver malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years
* Evidence of metastatic disease prior to registration
* Evidence of main portal vein thrombosis
* History of known cardiac ischemia or stroke within last 6 months
* Any concurrent medical or psychosocial condition that prohibits a major surgical procedure or immunosuppression that would constitute a contraindication to liver transplantation