Inclusion Criteria:

- HCC diagnosed as (i) the presence of risk factors including hepatitis B or C virus
and liver cirrhosis, a serum a-fetoprotein (AFP) level greater than 200 IU/ml and a
radiologically compatible feature with HCC in one or more CT/MRI/angiograms, or (ii)
the presence of risk factors including hepatitis B or C virus and liver cirrhosis, a
serum a-fetoprotein (AFP) level less than 200 IU/ml, and a radiologically compatible
feature with HCC in two or more CT/MRI/angiograms or (iii) histological confirmation

- HCC patients who were not prospective suitable or refused for any other treatment,
such as surgery or local ablation therapy, or recurrent or residual tumor after other
treatments.

- without evidence of extrahepatic metastasis

- All target tumors must be encompassable within single irradiation field (15x15 cm
maximum)

- no previous treatment to target tumors by other forms of RT

- liver function of Child-Pugh class A or B7 (Child-Pugh score of ≤7)

- Age of ≥18 years

- performance status of 0 to 2 on the Eastern Cooperative Oncology Group (ECOG) score

- WBC count ≥ 2,000/mm3; hemoglobin level ≥ 7.5 g/dL; platelet count ≥ 25,000/mm3; and
adequate hepatic function (total bilirubin ≤ 3.0 mg/dL; AST and ALT < 5.0× upper
limit of normal; no ascites)

- no serious comorbidities other than liver cirrhosis

- written informed consent

Exclusion Criteria:

- evidence of extrahepatic metastasis

- age < 18 years

- liver function of Child-Pugh class B8-9 and C (Child-Pugh score of >7)

- previous history of other forms of RT adjacent to target tumors

- poor performance status of 3 to 4 on the Eastern Cooperative Oncology Group (ECOG)
score

- multicentric HCCs, except for those with the following two conditions: *multinodular
aggregating HCC that could be encompassed by single clinical target volume and within
single irradiation field (15x15 cm maximum) *lesions other than targeted tumor that
were judged as controlled with prior surgery and/or local ablation therapy.