Hepatocellular carcinoma (HCC) is the most frequently occurring primary tumor of the liver in adults and the fourth most common cause of cancer-related deaths in the world. Its rising incidence in the United States and Europe is attributed to the increased incidence of hepatitis C infection. Currently, the optimal treatment for HCC is orthotopic liver transplant or surgical resection for selected patients. However many patients are not able to undergo these radical interventions. Historically, radiotherapy for hepatocellular carcinoma has been shown to be poorly tolerated in the cirrhotic liver and has had suboptimal results with standard fractionation. With the introduction of stereotactic body radiotherapy (SBRT) techniques, there are emerging data indicating that the use of targeted, highly conformal, hypofractionated ablative radiotherapy can provide results that compare favorably with other ablative procedures for HCC in terms of local control, safety and survival. Therefore, SBRT is gaining interest as an alternative, safe, non-invasive and effective technique for the treatment of appropriately selected patients who are not able to undergo orthotopic liver transplantation.