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Objective: Hepatocellular carcinoma (HCC) is among the most common and rapidly increasing cancers in Pakistan. There is currently no standard management for advanced HCC. The aim of the study was to assess response rate and toxicity of concomitant gemcitabine and external radiation therapy (ERT) in locally advanced HCC. Methods: Sixty patients were enrolled. Gemcitabine, 70 mg/m2 was given weekly during ERT. ERT was delivered with 60Co beam up to 30.6 Gy, 1.8 Gy/fraction. Tumor response was assessed by computed tomography (CT) at eight weeks. Complete and partial response (CR and PR), progressive and stable disease (PD and SD) were assessed. Hematological, gastrointestinal and hepatic toxicities were assessed weekly. Results: No CR was seen. PR, SD and PD were seen in 33%, 40% and 27% of patients respectively. Grade 3/4 toxicity for total leukocyte count and platelets was observed in 7% and 27% patients. Grade 3/4 toxicity for liver failure, bilirubin, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase was seen in 35%, 28%, 38%, 24% and 43% patients respectively. Conclusion: The study showed that concomitant gemcitabine and ERT is a feasible option with moderate toxicity in advanced HCC.