Surgical resection and orthotropic liver transplant (OLT) have been established as curative options for Hepatocellular Carcinoma (HCC). However, various factors delay surgical therapy and there is often a long waiting time for donor liver. Alternative, as well as temporizing, therapeutic options include transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT). We evaluated the efficacy and safety of combined TACE followed by SBRT for the treatment of primary HCC. From August 2011 to October 2012, 25 patients received sequential TACE followed by SBRT for HCC lesions at our institution: 11 Child-Turcotte-Pugh (CTP) Class A and 14 CTP Class B. 24 patients had HCC and 1 had mixed histology of HCC with cholangiocarcinoma. Twenty-three patients had a single lesion treated and 2 patients had 2 lesions treated. Seventeen patients had Hepatitis C and 4 had Hepatitis B. The median time from TACE to SBRT was 5 days (range, 2-49 days). The median dose, dose per fraction, and number of fractions was 4000 cGy (range, 1200-4000 cGy), 800 (range, 600-800 cGy), and 5 (range, 2-5 cGy), respectively. All patients were treated with cone beam CT (CBCT) imaging, with treatment delivered every other day. Abdominal compression was utilized in 21 patients and an ITV was generated via 4DCT for 23 patients. The mean GTV and ITV volumes were 32.4 cc (range, 0.5-104.2 cc) and 196.8 cc (range, 2.5-196.8 cc). Treatment response was scored according to the Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Regional failure was defined as intrahepatic progression of disease outside of the treated lesion. Local control (LC), disease free survival (DFS), and time to progression (TTP) were calculated according to the method of Kaplan-Meier. The mean follow-up time was 6.9 months (range, 1-12.7 months). Twenty-five (100%) patients experienced local control over this time period. The 8 month DFS was 71%, with 4 regional and 2 distant failures occurring in 4 patients. Median TTP was 7.8 months. 17 (68%) patients experienced complete response of tumor to treatment; 4 (16%) patients had a partial response and 1 (4%) had stable disease. The mean time to radiographic CR was 4.4 months (range, 1-9 months). Two patients had treatment truncated unrelated to treatment toxicity and three candidates went on to transplant. Two patients experienced grade 1 nausea one month post treatment and three experienced abdominal discomfort for which they were prescribed analgesic medicine. Two CTP Class B patients with pre-existing ascites experienced an increase in ascites post-treatment. Combined TACE followed by SBRT is a feasible therapeutic option which is well tolerated and can provide outstanding local control for primary HCC lesions. Further follow-up is needed to better characterize treatment outcome.