• To compare participants with treatment-related adverse events as assessed by CTCAE v5.0 [ Time Frame: At each treatment, 2 weeks post treatment, 2 months post treatment, 5 months post treatment, every 3 months until 24 months post treatment ]
• Number of further interventions [ Time Frame: 2 weeks post treatment, 2 months post treatment, 5 months post treatment, every 3 months until 24 months post treatment ]
• Rate of pathological response of treated lesion(s) [ Time Frame: Review of pathology report after liver transplant ]
• Rate of radiological response of treated lesion(s) [ Time Frame: Baseline, 2 months post-treatment, 5 months post-treatment, every 3 months thereafter until 2 years post treatment ]
• To assess Quality of Life by Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) Questionnaire [ Time Frame: Baseline, during treatment, 2 months post-treatment, 5 months post-treatment, every 3 months until 24 months post treatment ]
  A 45-item self-report instrument to measure health-related quality of life (HRQL) in patients with hepatobiliary cancers and is one of the most widely-used instruments in this clinical area. The FACT-Hep consists of the 27-item FACT-G, assesses HRQL, and the 18-item Hepatobiliary Subscale (HS), assesses disease-specific issues such as pain, appetite, and cramping. The FACT-G evaluates physical well-being, social/family well-being, emotional well-being, and functional well-being. Sections have a 7-day reference period and are scored from 0-4 ("not at all" to "very much"), with higher scores indicating better HRQL. Score ranges are 0-28 for physical well-being, 0-28 for social/family well-being, 0-24 for emotional well-being, 0-28 for functional well-being, and 0-72 for the HS. All subscale scores from the FACT-G and HS can be summed together to create a total FACT-Hep score, with a possible range of 0-180. The FACT-Hep takes approximately 10 minutes to complete.
• To assess over survival [ Time Frame: Baseline, during treatment, 2 months post-treatment, 5 months post-treatment, every 3 months until 24 months post treatment ]
• To assess 90 day Post-transplant morbidity [ Time Frame: Disease status to be captured 90 days post-transplantation (+/- 2 weeks) ]
• To assess 90 day Post-transplant mortality [ Time Frame: Survival status to be captured 90 days post-transplantation (+/- 2 weeks) ]

• Hepatocellular Carcinoma
• HCC

• Radiation: Stereotactic Body Radiation Therapy (SBRT)
  SBRT will be delivered in five total fractions, with at a minimum of one day between any two treatments. The entire treatment must be delivered within 15 total days.
  Other Name: Radiation Therapy
• Procedure: Trans-Arterial Chemoembolization (TACE)
  First day will be administered and a second TACE will be administered after 4 weeks and subsequently if imaging is showing disease progression. Following each TACE procedure all patients will remain in hospital for observation
  Other Name: Chemoembolization
• Drug: Doxorubin
  This procedure will be completed with 2 vials of drug eluting beads each loaded with 50 mg of Doxorubin.
  Other Name: Doxorubin bead therapy

• Stereotactic Body Radiation Therapy (SBRT)
  Radiation Therapy
  Intervention: Radiation: Stereotactic Body Radiation Therapy (SBRT)
• Trans-Arterial Chemoembolization (TACE)
  Procedure/Surgery - Chemoembolization Drug: Doxorubin
  Interventions:

  • Procedure: Trans-Arterial Chemoembolization (TACE)
  • Drug: Doxorubin

Inclusion Criteria:

1. Subjects with HCC are eligible for this trial. HCC is defined as having at least one of the following:

   • Biopsy proven HCC or:
   • A discrete hepatic tumor(s) as defined by the Barcelona (29) criteria for cirrhotic subjects, ≥2cm with arterial hypervascularity and venous or delayed phase washout on CT or MRI.
2. Subjects are liver transplant candidates (actively awaiting organ transplant per transplant services in documentation), or, potential liver transplant candidates (at the discretion of the liver team and/or Principal Investigator) advised by liver transplant services as needing local treatment prior to liver transplant evaluation.
3. Subjects must be within UCSF criteria (one solitary tumor smaller than 6.5 cm, or patients having 3 or fewer nodules, with the largest lesion being smaller than 4.5 cm or having a total tumor diameter less than 8.5 cm without vascular invasion) and eligible for potential liver transplant.
4. Subjects must be eligible per standard of care for either TACE or SBRT procedures.
5. Subjects must have a life expectancy of at least 12 weeks.
6. Subjects must be 18 years of age or older. Adult subjects of all ages, both sexes and all races will be included in this study.
7. Subjects must sign an informed consent form approved for this purpose by the Institutional Review Board (IRB) of record .
8. Subjects must have a Child-Turcotte-Pugh (CTP) score ≤8.

9. Patients must have adequate organ function within 2 weeks of enrollment.

   • Bone marrow: Platelets ≥30,000/mm3
   • Renal: BUN ≤40 mg/dl; creatinine ≤2.0 mg/dl
   • Hepatic: INR ≤ 1.5 or correctable by Vitamin K, unless anti-coagulated for another medical reason
   • Bilirubin < 3.0 mg/dl (in the absence of obstruction or pre-existing disease of the biliary tract, e.g. primary sclerosing cholangitis).
10. Patients uninvolved liver volume will be estimated and must be > 700ml.
11. Patients must have a Zubrod performance status of ≤2.

Exclusion Criteria:

1. Subjects in a "special category" designated by the Public Health Service, Including subjects younger than 18, pregnant women, and prisoners.
2. Refractory ascites that requires paracentesis for management.
3. Known allergy to intravenous iodinated contrast agents unresponsive to prednisone pre-treatment.
4. History of prior radiation to the liver.
5. Evidence of metastatic disease.
6. Presence of a Trans-jugular intra-hepatic porto-systemic shunt (TIPS).

• Varian Medical Systems
• Merit Medical Systems, Inc.