Transarterial Chemoembolization vs CyberKnife for Recurrent Hepatocellular Carcinoma

Inclusion Criteria: * Confirmed hepatocellular carcinoma by one of the following: * Histopathology * One radiographic technique that confirms a lesion \>=2 cm with arterial enhancement with washout on delayed phase * Hepatic lesion in patients for whom surgical resection is not possible or would not result in an opportunity for cure * Radiographic evidence of persistent, progressive or recurrent disease in an area previously treated with TACE. This evaluation should be determined after 6 weeks of initial TACE * Multi-specialty evaluation whereby the recurrent liver lesion was deemed by both the attending radiation oncologist and interventional radiologist amenable to treatment by the respective modality * Eligible patients must undergo an IV contrast CT scan of the liver within 6 weeks of enrollment onto the study; a contrast enhanced liver MRI may be substituted for the IV contrast CT of the liver. * A recent serum AFP must also be obtained within 4 weeks of enrollment. * Unifocal liver tumors not to exceed 7.5 cm in greatest axial dimension. Multifocal lesions will be restricted to lesions that can be treated within a single target volume within the same liver segment and to an aggregate of 7.5cm as long as the dose constraints to normal tissue can be met * Eastern Clinical Oncology Group performance status 0, 1 or 2 * Patients with liver disease classified as Child Pugh class A/B; if Child's class B, score must be 8 or less * Albumin \>= 2.5 g/dL * Total bilirubin \<= 3 mg/dL * INR \<= 1.5 * Creatinine \<= 2.0 mg/dL * Age \>= 18 years old * Life expectancy\>= 6 months * Ability of the research subject or authorized legal representative to understand and the willingness to sign a written informed consent document. Exclusion Criteria: * Prior radiation for the recurrent liver tumors * Prior radiotherapy to the upper abdomen * Prior RFA to index lesion * Liver transplant * Tumors \>= 7.5 cm in greatest axial dimension * Portal vein thrombus * Large varices within 2 cm of index lesion (seen on cross section imaging) * Contraindication to receiving radiotherapy * Active gastrointestinal bleed within 2 weeks of study enrollment * Ascites refractory to medical therapy * Women who are pregnant * Administration of any systemic chemotherapy within the last 1 month * Presence of multifocal lesions located in different lobes of the liver or extrahepatic metastases * Participation in another concurrent SYSTEMIC treatment protocol * Prior history of malignancy other than HCC