Sorafenib-RT in Treating Hepatocellular Carcinoma (SHEP)

Inclusion Criteria: * Patients must have HCC either * confirmed pathologically * diagnosed by showing vascular enhancement of the lesion on at least two imaging techniques * diagnosed by showing vascular enhancement on a single technique if the AFP is over 200, in the setting of cirrhosis or chronic hepatitis B without cirrhosis. Biopsies are mandatory (unless an absolute contraindication exists). * The tumour must be unresectable or medically inoperable * At least 800 cc of non-tumor liver * Patients must be \> 4 weeks since any major surgery. * Patients may have had previous systemic treatment (with at least a 2 week break from systemic therapy to start of radiation therapy. Prior sorafenib or any other targeted therapy with anti-VEGF activity is not permitted. * Child-Pugh Liver score A * Barcelona-Clinic Liver Cancer (BCLC) score A or B or C (BCLC C permitted if ECOG 0-1 and Child Pugh A, with portal invasion) * Age 18 years or older. * Life expectancy of equal to or greater than 3 months. * ECOG performance status 0-1. * Patients must have normal organ and marrow function. * Ability to understand and the willingness to sign a written informed consent document. * Negative pregnancy test for women of child bearing age * If the patient has a history of varices and portal hypertension, elective treatment (e.g. banding) of varices will be performed prior to start of radiation therapy. * The effects of Sorafenib on the developing human fetus are unknown. For this reaso…