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INTRODUCTION In clinical practice, it remains unclear whether cirrhotic livers in patients with hepatocellular carcinoma (HCC) can withstand repeated stereotactic body radiotherapy (SBRT). This study aimed to evaluate outcomes and toxicities in such patients. METHODS AND MATERIALS This retrospective study included patients with HCC who were treated with SBRT at least twice between January 2012 and June 2019. Local control and overall survival rates were calculated. Liver function before and after irradiation was evaluated using the Child-Pugh score and modified albumin-bilirubin grade. All toxicities were assessed using the Common Terminology Criteria for Adverse Events (version 4.0). RESULTS Fifty-two patients underwent 136 courses (148 lesions) of SBRT, which was mostly performed for out-of-field tumors but three in-field recurrences. The median follow-up duration from the first SBRT was 52.6 months (range 15.7-89.3). The median gross tumor volume was 4.6 cc (range 0.8-55.2) at the second SBRT. The 3-year local control rate was 94.5% (95% confidence interval: 88.0-97.5). The 3-year overall survival rate following the second course was 62.8% (95% confidence interval: 45.1-76.2). Although the Child-Pugh score did not deteriorate after the second course, deterioration of the modified albumin-bilirubin grade at 6, 12, and 24 months was statistically significant compared with that before the second course. One patient (1.9%) experienced grade 3 hypoalbuminemia and two (3.8%) had grade 3 thrombocytopenia 6 months after the second course. Mild fatigue and nausea were reported in nine (17.3%) and six (11.5%) patients. One instance of grade 5 toxicity was observed. Two patients (1.5%) had grade 2 gastric ulcers. No other grade ≥3 gastrointestinal toxicities occurred. CONCLUSIONS Repeated SBRT is feasible and produces minimal toxicity in HCC patients with Child-Pugh scores of ≤7 and a low normal liver dose.