Five-year survival studies in patients with advanced gynecologic pelvic malignancy treated with intra-arterial chemotherapy followed by radiotherapy have not been reported in the literature. Forty-six evaluable patients entered into a study between 1981 and 1985 at the University of Texas-M.D. Anderson Cancer Center were reviewed for follow-up. Two patients were FIGO (International Federation of Gynecology and Obstetrics) Stage IIB cervical cancer, thirty-one patients were Stage III cervical cancer, seven patients were Stage IVA cervical cancer, and six patients were unstaged, cut-through cervical cancer, or primary vaginal carcinoma with bulky tumor volume. Seventeen patients had evidence of obstructive uropathy by intravenous pyelogram. Pretreatment lymphangiogram was carried out in 32 patients, 14 of whom were positive for pelvic lymph node involvement. Forty-four patients had received no prior therapy before initiating intra-arterial chemotherapy. Thirty-five (76%) of the patients responded to locally infused pelvic intra-arterial chemotherapeutic agents consisting of mitomycin-C, bleomycin, and cisplatin. Vincristine was given peripherally by intravenous access. There were 24 (52%) partial responders, 11 (24%) complete responders, and 11 (24%) nonresponders. Two (4%) patients progressed during treatment, while twenty-six (57%) patients relapsed after receiving chemotherapy followed by radiotherapy. Three additional patients died from treatment-related causes, one secondary to renal failure, one to massive pulmonary embolus, and one from a combination of pulmonary toxicity secondary to bleomycin and sepsis. Three of fifteen patients in complete remission died from unrelated causes with no evidence of disease. The 5-year survival rate for the study group was 30%, with a median survival duration of 18 months.