Stereotactic Body Radiation Therapy in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery

Inclusion Criteria

• •Life expectancy \> 3 months
• •Eastern Cooperative Oncology Group (ECOG) performance status =\< 2
• •HCC diagnosed by either of the following approaches:
• •* Histologic confirmation of HCC on biopsy
• •* Evidence of vascular enhancement of suspected lesion on at least two imaging techniques
• •* Evidence of vascular enhancement on a single technique if the alpha-fetoprotein (AFP) is \> 200 ng/mL in the setting of cirrhosis or chronic hepatitis B/C
• •HCC must be deemed unresectable by an experienced surgeon or patient must be medically inoperable or extra-hepatic metastases must be present (making resection an inappropriate treatment option) or patient must have declined the option of surgery after consultation with a surgeon
• •* Barcelona Clinic Liver Cancer score of B or C required (i.e., intermediate or advanced stage HCC)
• •Prior liver resection or ablative therapy is permitted
• •Prior transarterial chemoembolization (TACE) is permitted
• •Patients must have recovered from the effects of previous therapy
• •Maximal tumor size of 15 cm and \> 700 cc of uninvolved liver
• •Hemoglobin \> 9.0 g/L
• •Absolute neutrophil count \>= 1.0 bil/L
• •Platelets \>= 70,000 bil/L
• •Total bilirubin \< 2 mg/dL
• •International normalized ratio (INR) =\< 1.5 or correctable with vitamin K (higher INR acceptable if patient is on Coumadin)
• •Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =\< 6 times upper range of normal