Radiotherapy for Hepatocellular Carcinoma

Inclusion Criteria: * Patients aged ≥ 18 years old * Eastern Cooperative Oncology Group (ECOG) performance 0 to 1 * Confirmed diagnosis of Hepatocellular carcinoma (HCC) * Tumour size ≥ 3cm * Patients planning on undergoing Stereotactic Body Radiation Therapy (SBRT) for HCC * Prior radiofrequency ablation at a different site, or prior surgery are eligible * Child-Pugh A liver function * Life expectancy longer than 12 weeks * At least one measurable treatment lesion according to RECIST 1.1 * Written informed consent must be obtained prior to any study related procedures * Adequate haematological function (Hemoglobin ≥ 8.5g/dL; Platelet Count ≥ 75x109/L; Antenatal Care ≥ 1.5x109/L; international normalised ratio ≤ 1.5) * Adequate hepatic function (albumin ≥ 28g/l; Bilirubin ≤ 1.5xULN; Alanine transaminase \< 5 times upper limit normal) * Adequate renal function (serum creatinine ≤ 1.5 times the upper limit of normal range; Sodium ≥ 130mmol/L; Potassium ≥ 3.0mmol/L) * Able to read, understand and provide written consent Exclusion Criteria: * Histology shows sarcomatoid HCC, fibrolamellar HCC, mixed cholangiocarcinoma-hepatocellular carcinoma * Presence of other malignancy than HCC within 5 years from diagnosis of HCC * Prior Transarterial chemoembolization (TACE) within 3 months * Previous radiotherapy to the abdomen * Previous yttrium-90 chemoembolization * Repetitive history of non-healing wounds or ulcers within 2 months of inclusion * Pregnant or lactating females at any time during the study * Active autoimmune disease requiring systemic therapy in the past 2 years * Diagnosis of immunodeficiency (including Human Immunodeficiency Viruses) * Patients with coagulopathy or on anticoagulant will be excluded from liver biopsy