Hepatocellular carcinoma (HCC) is a leading cause of cancer death. Experience with radiotherapy for HCC is increasing. Stereotactic body radiotherapy allows the delivery of tumoricidal doses in 3 to 6 treatments to focal HCC with low rates of toxicity and excellent local control. Stereotactic body radiotherapy can be used to control disease in patients unsuitable for other conventional therapies. How it might optimally be used to improve outcomes, including its use in combination with other therapies, is an area of active research, and further randomized studies are needed. This review discusses the current literature and possible future treatment and research opportunities.