Transarterial Chemoembolization (TACE) With Radiation Therapy (RT) in Advanced Hepatocellular Carcinoma (HCC)

Inclusion Criteria: 1. Patients must have a diagnosis of HCC by at least one criterion listed below (korean liver cancer study group (KLCSG) guideline 2009) 1.1 Pathologically (histologically or cytologically) proven diagnosis of HCC 1.2 Liver nodule in high risk group 1.2.1 If alpha fetoprotein (AFP) ≥200 ng/mL , ≥ 1 typical HCC enhancing pattern on dynamic contrast enhanced CT or MRI 1.2.2 If AFP\<200 ng/mL, ≥2 typical HCC enhancing pattern on dynamic contrast enhanced CT, MRI, and angiography 1.3 ≥ 2 cm nodule in liver cirrhosis (LC), ≥ 1 typical HCC enhancing pattern on dynamic contrast enhanced CT or MRI 2. Patients must have a diagnosis of PVTT 2.1 Early arterial enhancement and delayed washout on multiphasic CT or MRI 3. Eastern cooperative oncology group performance status 0 1 2 4. Age ≥ 20 and 70 or less 5. Unsuitable for resection or transplant or radiofrequency ablation (RFA) 6. Unsuitable for or refractory to TACE or drug eluting beads (DEB) 7. Agreement of study-specific informed consent 8. Assessment by radiation oncologist and medical oncologist or hepatologist within 28 days prior to study entry? 9. Child-Pugh score A-B within 7 days prior to study entry 10. Normal liver (Liver minus gross tumor volume) ≥ 700 cc 11. Blood work requirements * Absolute neutrophil count (ANC) ≥ 1,500 /mm3, Platelet ≥ 70,000/mm3, Hgb ≥ 8 g/dl * Liver function test (LFT): Total bilirubin\<3.0 mg/dL, International normalized ratio(INR) \< 1.7, Albumin ≥ 2.8g/dL, Aspartate aminotransferase (AST)/Alanine aminotransferase (ALT)\< 6 X normal * Serum creatinine \< 1.5 X normal, or creatinine clearance ≥ 60 mL/min 12. Male, consent contraception at least 6 months 13. Childbearing potential woman, consent contraception at least 6 months 14. Life expectancy more than 12 weeks 15. Stable breathing more than 5 minutes Exclusion Criteria: * 1\. Complete obstruction of main portal vein 2. Pregnant and/or breastfeeding woman 3. Previous upper abdominal RT history 4. Uncontrolled active co-morbidity 5. Another primary cancer history within 2 years 6. Uncontrolled ascites or hepatic encephalopathy 7. Connective tissue disease which known as radiation hypersensitivity 8. Uncontrolled moderate to severe gastroduodenal ulcer or esophagogastric varices