AS-252424 incidence of abscess formation in this setting, variable reports suggest it is in the range of 2 5 .17 19 Abscess formation is dependent on tumor size as well as the amount of material placed into the tumor. The risk of abscess is also dependent upon whether an arterial occlusion method is employed following the primary embolic method, and risk is directly related to the amount of ischemia present. Because of the potential seriousness of abscess formation, it is important to inform the patient of this risk and to employ antibiotic prophylaxis. The antibiotic regimen is typically ciprofloxacin or ofloxacin in combination with metronidazole, administered for 5 days following the ablation procedure.
For Cuscutin inpatients who are more ill or at greater risk of developing an infection, intravenous antibiotics may be administered for 1 3 days following the procedure. Doxorubicin, once more widely used as an intravenous chemotherapy agent to treat HCC, has essentially been completely replaced by sorafenib and clinical trial enrollment for other systemic therapies of HCC that are in development. Doxorubicin use is associated with substantial accumulation, leading to cardiotoxicity in patients with previous cardiac dysfunction or elevated levels of bilirubin. This adverse event has limited the use of intravenous doxorubicin in HCC patients who are jaundiced or who have known cardiac or myocardium dysfunction, congestive heart failure, or low cardiac output. The systemic exposure of doxorubicin when it is used in bead embolization is very low, in contrast to that associated with intravenous administration.
Because the therapy can be targeted to the tumor cells, patients have minimal exposure to the doxorubicin, and they therefore experience far fewer associated adverse events, such as cardiotoxicity, bone marrow suppression, and hair loss. Postembolization syndrome is observed with bead embolization and is related to tumor ischemia and breakdown products from the tumor cells that are released into the bloodstream. Symptoms of postembolization syndrome typically include pain, fever, and short periods of hypotension, they are managed with supportive care. With advances in injection technique, most patients can be discharged home within 24 hours from the time of bead embolization.
Systemic Therapy Systemic therapy is now considered the standard of care for patients with BCLC stage C tumors, and patients with stage A and B HCC are now increasingly treated with sorafenib. The label for sorafenib states that it is indicated for patients with unresectable HCC, and thus utilization continues to broaden. The risks and benefits of timing and incorporation of sorafenib therapy with resection or ablative techniques are not yet known. These questions are under investigation in 2 major clinical trials, the phase IV Sorafenib or Placebo in Combination with Transarterial Chemoembolization for Intermediate Stage HCC 20 and the phase IV S 
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