Radiotherapy has long been investigated as a therapeutic modality in the management of hepatocellular carcinoma (HCC). Recently, updated clinical frameworks in the Barcelona Clinic Liver Cancer guidelines have allowed greater flexibility in integrating radiotherapy across disease stages. This review synthesizes contemporary prospective studies and systematic reviews/meta-analyses published over the past five years to clarify the current and emerging clinical roles of radiotherapy in real-world HCC management. Recent evidence highlights expanding applications of radiotherapy, including curative-intent stereotactic body radiotherapy in early-stage disease, consolidation after incomplete transarterial chemoembolization, perioperative strategies, and treatment of macroscopic vascular invasion. Radiotherapy is increasingly integrated with tyrosine kinase inhibitors and immune checkpoint inhibitors in advanced, oligometastatic, and oligoprogressive settings. In addition, particle therapies further broaden therapeutic options for liver-confined or anatomically challenging tumors. Collectively, contemporary data indicate that radiotherapy has evolved from a predominantly supportive modality to a versatile and increasingly evidence-based component of multidisciplinary treatment strategies for HCC.
