A Study of Standard Of Care Versus Radio Ablation in Early Stage HCC

Inclusion Criteria: 1\) Histological or radiological diagnosis of single, new HCC with largest diameter =8 cm (BCLC stage 0 or A). * a) If prior history of HCC, the prior HCC must have been: * Early stage, solitary HCC, =5 cm in size and, * Have arisen within a different liver segment to the current HCC and, * Treated with curative intent therapy \>2 years prior with no evidence of active disease at the site. * 2\) As per local multidisciplinary HCC meeting consensus patient is suitable for percutaneous thermal ablation and/or transarterial therapies and not suitable for or declined liver resection and not planned for liver transplantation. * 3\) Child-Pugh score =B7\* with no or diuretic-controlled ascites * 4\) ECOG performance status =2 * 5\) Platelets =50x109/L, Haemoglobin =80 g/L, Neutrophils =1.0x109/L, INR \<1.8 (except if on therapeutic anticoagulation) * 6\) 18 years of age or older and able to provide written consent Exclusion Criteria: * 1\) Presence of multifocal HCC, macrovascular invasion or extrahepatic disease * 2\) Prior treatment for any HCC within last 2 years. * 3\) Clinically evident ascites or hepatic encephalopathy * 4\) Prior abdominal radiation therapy that would preclude the delivery of protocol defined SABR to the tumour. * 5\) Untreated Hepatitis B or C * 6\) Known additional invasive malignancy (excluding non-melanoma skin cancer) that is progressing or required treatment within the last 2 years. * 7\) Pregnancy