Radiation Therapy in Treating Patients With Hepatocellular Carcinoma, Cholangiocarcinoma, or Liver Metastasis Who Have Impaired Liver Function

Inclusion Criteria:

* Diagnosis of hepatocellular carcinoma, cholangiocarcinoma, or liver metastasis from any histology
* Patients may have single or multinodular tumors
* There is no specific tumor size cut-off for this protocol; however, the radiation treatment plan must meet the protocol's dose constraints
* Compromised liver function as defined by any of the following:

  * Cohort 1: Advanced cirrhosis group

    * Borderline Child-Pugh class A6
    * Child-Pugh class B

      * The patients in this advanced cirrhosis group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (computed tomography \[CT\] or magnetic resonance imaging \[MRI\]) or single photon emission computed tomography (SPECT)/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
  * Cohort 2: Low functional liver volume without underlying chronic liver disease

    * Previous irinotecan or oxaliplatin chemotherapy
    * Previous liver resection(s)

      * These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging computed tomography or magnetic resonance imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients;
  * Cohort 3: History of prior liver-directed radiation therapy with either fractionated external beam radiation therapy (EBRT), stereotactic body radiation therapy (SBRT) or yttrium-90 radioembolization (Y90 RE); the interval between prior EBRT and re-irradiation on protocol should be equal to or greater than 12 months; the interval between prior Y90 RE and re-irradiation on protocol should be equal to or greater than 6 months;

    * Cirrhosis group:

      * Child-Pugh class A5;
      * Borderline Child-Pugh class A6;
      * The patients in this group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
  * Low functional liver volume without underlying liver disease

    * Previous irinotecan or oxaliplatin chemotherapy
    * Previous liver resection(s)
    * These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2
* Women of childbearing potential (those who have not undergone a hysterectomy or who have not been postmenopausal for at least 24 consecutive months) must agree to practice adequate contraception and to refrain from breast feeding
* Prior history of surgical resection, chemotherapy, transarterial chemoembolization (TACE), and/or radiofrequency ablation are allowed
* Expected survival must be greater than 3 months
* Patients may receive concurrent capecitabine or sorafenib at the discretion of the treating physicians
* Signed study-specific consent form

Exclusion Criteria:

* Prior liver-directed radiation therapy in cohort 1 (advanced cirrhosis group) or cohort 2 (low functional volume group)
* Prior yttrium-90 therapy for patients in cohorts 1 or 2
* Patients with a Child-Pugh score less than 6 or greater than 9 for radiation naive patients with cirrhosis (cohort 1)
* Child-Pugh score of greater than 6 for patients with cirrhosis who previously received liver directed radiation (EBRT or Y90 RE) (cohort 3)
* Unstable angina and/or symptomatic congestive heart failure requiring hospitalization within the last 6 months; transmural myocardial infarction within the last 6 months prior to study entry
* Current evidence of fever or untreated infection
* Active hepatitis, including but not limited to viral and drug-induced
* Poorly controlled inflammatory bowel disease
* Women with a positive pregnancy test
* Inability to comply with study and/or follow-up procedures
* Patients with an active second malignancy or prior invasive malignancy unless disease free for a minimum of 3 years; non-melanoma skin cancer and previous early prostate cancer that had a non-rising prostate-specific antigen (PSA) can be enrolled