In vitro studies and clinical experience have suggested that patients with platinum-refractory epithelial ovarian carcinoma exhibit cross-resistance to radiation. Salvage with radiation in these patients is rare. However, radiation is often utilized to palliate symptoms caused by these chemotherapy-resistant tumors. Forty-seven patients with platinum-refractory epithelial ovarian carcinoma were referred for palliative radiation and 33 (70%) were evaluable for response. One to four regimens of platinum-based chemotherapy (median 2.7) were given to each patient prior to radiation therapy. Of the 33 evaluable patients, 23 (69.7%) had a complete resolution of symptoms after radiation, 8 (24%) had a partial resolution, and 2 were unassessable because of unrelated medical complications. The median duration of response was 11 months (range 1-86) and closely approximated their survival. Thirteen of 33 patients (39%) obtained relief of symptoms for greater than 12 months, with 10 of 33 (30%) having symptoms controlled for 6 to 12 months. In only 10 patients (30%) was the duration of palliation less than or equal to 6 months. Four patients required reirradiation to the same area for recurrence of their symptom. External-beam radiation therapy can provide effective and durable palliation of symptoms in platinum-refractory epithelial ovarian carcinoma patients.