Transarterial Chemoembolization (TACE) With or Without Stereotactic Body Radiotherapy (SBRT) in Hepatocellular Carinoma

Inclusion Criteria:

* HCC (diagnosed through biopsy or radiological criteria)
* Age \>18 years of age
* Number of lesions: not more than 3 lesions
* Lesion size: up to 10 cm (and up to 10 cm cumulative diameter)
* Unilobar +/- segment 4
* Child-Pugh A within 6 weeks prior to study entry
* Barcelona Clinic (BCLC) Stage A/B
* Absence of comorbidities
* ECOG Performance Status 0-2
* Must be fit (eligible) for RT and TACE
* Unsuitable/unwilling for resection or transplant or radiofrequency ablation (RFA) or if these options are not available
* All blood work obtained within 6 weeks prior to study entry with adequate organ marrow function defined as follows:

Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3 Platelets ≥ 50,000 cells/mm3 Hemoglobin ≥ 8.0 g/dl (Note: The use of transfusion or other intervention to achieve Hgb ≥ 8.0 g/dl is acceptable.) Total bilirubin \< 2 mg/dL Prothrombin time/INR \< 1.7 (unless on Coumadin/Warfarin) Albumin ≥ 28 g/L AST and ALT \< 5 times ULN Serum creatinine ≤ 1.5 x ULN or creatinine clearance ≥ 60 mL/min

* May have had previous surgery, ethanol injection and RFA to the liver
* No evidence of metastatic disease including nodal or distant metastases (clinically defined by each institution).
* Distance between GTV (lesion) and luminal structures (including esophagus, stomach, duodenum, small or large bowel) is \>5 mm

Exclusion Criteria:

* Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 2 years (Note that carcinoma in situ of the breast, oral cavity, or cervix are all permissible). No active cancer therapy.
* Major vascular invasion/thrombus
* Unsuitable for or refractory to transarterial hepatic chemo-embolization (TACE) Raoul et al (2011)
* Previous TACE and radiation to the liver (including SIRT )
* Life-threatening condition including untreated HIV and active hepatitis B/C
* Pregnancy or women of childbearing potential require a negative pregnancy test within 28 days