Purpose <p>This study aimed at analyzing and comparing the clinical efficacy and prognosis of stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (RHCC).</p> Methods <p>Clinicopathological data of RHCC patients who underwent RFA or SBRT as treatment from three medical centers were retrospectively reviewed. The survival outcomes of patients who underwent SBRT were compared with those who underwent RFA. Using the Kaplan–Meier method, survival curves for the two groups of patients were generated, and the log-rank test was used to compare survival differences. Propensity score matching (PSM) analysis was used to match patients of the SBRT and RFA groups in a 1:1 ratio.</p> Results <p>The SBRT group had a significantly better overall survival (OS) than the RFA group and no statistical differences were found in disease-free survival (DFS) in the two groups before and after PSM. After PSM, subgroup analysis demonstrated that, compared with the RFA group, the SBRT group had a significantly better OS in terms of tumor location in the subphrenic or subcapsular area, tumor size &gt; 2.5&#xa0;cm, and tumor proximity to major vessels ≤ 1&#xa0;cm.</p> Conclusions <p>SBRT appears to be an effective priority to RFA for RHCC patients especially when RFA is not feasible due to tumor location, size, and proximity to major vessels.</p>