Radiation Therapy With Protons or Photons in Treating Patients With Liver Cancer

Inclusion Criteria

• •Pathologically (histologically or cytologically) or radiographically-proven (based on the American Association for the Study of Liver Diseases \[AALSD\] criteria) unresectable or locally recurrent hepatocellular cancer prior to registration
• •Appropriate stage for study entry based on the following diagnostic workup:
• •* All patients must have computed tomography (CT) scan chest/abdomen/pelvis with multiphasic liver CT scan prior to registration; if CT contrast is contraindicated, CT chest without contrast and magnetic resonance imaging (MRI) of abdomen is permitted
• •* Participants must have measurable disease at study entry, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as \> 2 cm with conventional techniques or as \> 1 cm with spiral CT scan
• •* Patient must have 3 or fewer single or multinodular tumors; for patients with a single lesion, lesion must be 15 cm or less in greatest dimension; for patients with two lesions, no lesion may be greater than 10 cm in greatest dimension; for patients with three lesions, no lesion may be greater than 6 cm in greatest dimension; portal vein involvement or thrombosis combined with a single lesion that is \>= 1 cm and =\< 15 cm in greatest dimension is allowed
• •Age \>= 18
• •Zubrod performance status 0-1 within 30 days prior to registration
• •Negative urine or serum pregnancy test for women of childbearing potential within 7 days prior to study entry
• •Absolute neutrophil count (ANC) \>= 1,000 cells/mm\^3
• •Platelets \>= 50,000 cells/mm\^3
• •Hemoglobin \>= 9.0 g/dl; (Note: The use of transfusion or other intervention to achieve hemoglobin \[Hgb\] \>= 9.0 g/dl is acceptable)
• •Total bilirubin \< 4 x institutional upper limit of normal (ULN)
• •Transaminases (aspartate aminotransferase \[AST\] and alanine aminotransferase \[ALT\]) \< 6 x institutional ULN
• •Albumin \>= 2.5 g/dl
• •Creatinine \< 2 mg/dl
• •Prior chemotherapy, targeted biological therapy (e.g. sorafenib), surgery, transarterial chemoembolization (TACE), ablation for present disease is acceptable
• •Must have Child-Turcotte-Pugh (CTP) A or B7
• •The patient or a legally authorized representative must provide study-specific informed consent prior to study registration