This editorial argues evidence has tipped the scales in favor of routinely considering radiation for early- and intermediate-stage hepatocellular carcinoma (HCC) as opposed to considering it only to salvage failures following other local therapies. In RTOG 1112, adding 5-fraction ablative radiation to sorafenib nearly doubled progression-free survival and improved median overall survival despite narrowly missing conventional statistical significance (p=0.055). In the case of vascular invasion, the artery-independent dose delivery of external beam radiation offers particular advantages over transarterial radioembolization. It also highlights guideline updates from ASTRO (2022) and EASL (2024) recognizing ablative radiation as an upfront definitive treatment option and points to randomized data demonstrating superior local control versus radiofrequency ablation. | Good, Int J Radiat Oncol Biol Phys 2026
