Radiation Therapy With Sorafenib for TACE-Resistant Hepatocellular Carcinoma

Inclusion Criteria: * Radiographic or histologic diagnosis of hepatocellular carcinoma (HCC). * Maximum of 3 HCC lesions within the liver. * No evidence of lymphadenopathy or metastatic disease per either CT or PET. * Prior transarterial chemo-embolization (TACE) at least 28 days prior to initiation of protocol therapy. * Evidence of either progressive disease or stable disease following TACE. * Child Pugh Class A (score 5-6) or B (score 7). * Eastern Cooperative Oncology Group (ECOG) Performance Status ≤1 (or Karnofsky ≥70%). * Normal organ and marrow function (platelets \>60,000/mc; hemoglobin ≥8.5 g/dL; international normalized ratio (INR) ≤2.3; albumin ≥2.8 g/dL; total bilirubin ≤3 mg/dL; aspartate aminotransferase (AST) / alanine aminotransferase (ALT) \<5x upper limit of normal; creatinine ≤1.5x upper limit of normal). * Negative human immunodeficiency virus serology. * Negative pregnancy test for women of child bearing age. * Ability to understand and willingness to sign a written informed consent document. Exclusion Criteria: * Less than 800 cc of normal liver. * Child Pugh Class B (score 8-9) or C (score 10-15). * Acute/active hepatitis B infection. * Prior systemic chemotherapy or abdominal radiation therapy. * Portal venous (main, primary right, or primary left trunks) or inferior vena cava thrombosis. * Prior malignancy within 5 years of enrollment except for non-melanoma skin cancer. * Prior history of myocardial infarction, cerebrovascular accident, or esopha…