Background: TACE is a standard treatment for patients (pts) with HCC. SBRT is a newer, noninvasive therapy. There have been no comparative studies to date. Thus, we examined TACE and SBRT outcomes. Methods: After IRB approval, institutional HCC and radiotherapy databases were queried for pts receiving TACE or SBRT for 1-2 tumors and combined with a diagnosis and billing code query for HCC, TACE, and SBRT. Pts with main branch portal venous (PV) involvement, extrahepatic spread, and Child Pugh C cirrhosis were excluded, since they are not candidates for TACE. Inverse probability weighting, via a propensity score, was used to adjust for imbalances between treatment groups. Local control (LC), overall survival (OS), and toxicity were compared. LC for was defined as no tumor growth within or immediately adjacent to the TACE cavity or original tumor. Results: From 2006-2014, 84 pts with 114 tumors were treated with TACE and 125 pts with 173 tumors with SBRT. Median follow-up was 28 months (1.8-103) and 16 months (0.2-98) for pts treated with TACE or SBRT, respectively (p<0.001). Pts treated with TACE were younger (61 vs 65 yrs, p=0.01) and had slightly larger tumors (2.9 vs 2.3 cm, p<0.001). In propensity adjusted analysis, 1- and 2-yr LC favored SBRT: 97% and 91% for SBRT and 41% and 18%, for TACE (HR 18.8, 95% CI 6.7-52.7, p<0.001). Increasing tumor size (HR 1.2 per cm, 95% CI 1.05 - 1.23, p<0.001) and partial PV tumor thrombus (HR 7, 95% CI 2.73 - 15.2, p<0.001) predicted for worse LC in pts treated with TACE, but not with SBRT. Grade 3+ toxicity occurred after 14% and 7% of TACE and SBRT treatments, respectively (p=0.05). From HCC diagnosis, SBRT was initiated a mean of 9 months later than TACE (p<0.001), and more patients underwent liver transplantation after TACE (18% vs. 8%, p=0.01). After adjustment for baseline liver function and transplantation, overall survival was not significantly different (HR = 0.73, 95% CI 0.48 – 1.12, p =0.15). Conclusions: SBRT is a safe alternative to TACE for 1-2 tumors, and provides better LC, with no difference in OS. Prospective comparative trials of TACE, SBRT, and other ablative therapies are warranted.