Abstract:Portal vein tumor thrombus (PVTT) is a common manifestation of advanced hepatocellular carcinoma (HCC), associated with poor prognosis and significant treatment challenges. Although various therapeutic options-including surgery, systemic therapies, and local treatments such as interventional procedures and radiotherapy-are available for HCC with PVTT, monotherapies often yield limited efficacy, highlighting the need for combined treatment strategies. With the advancement of radiotherapy technologies, stereotactic body radiation therapy (SBRT) has gained increasing recognition due to its high precision, ablative doses, and fewer treatment fractions. SBRT plays a crucial role in palliative care, conversion therapy, neoadjuvant, and adjuvant settings. Recent studies have demonstrated that SBRT, either alone or in combination with other modalities, significantly improves overall survival and local control rates in patients with HCC and PVTT. This review summarizes the current research progress of SBRT in the management of HCC with PVTT, emphasizing both monotherapy and combined approaches with surgery, interventional therapy, targeted agents, and immunotherapy, aiming to provide insights for clinical decision-making.