OBJECTIVE To evaluate the clinical efficacy and toxicity of ifosfamide (IFO) combination chemotherapy in patients with advanced gynecologic malignancies. METHODS Thirty-four patients with gynecologic malignancies were included in this series. Of the 34 patients, 26 with epithelial cancer of the ovary were previously treated with cisplatin-containing combination chemotherapy but failed to respond or recurred after treatment. They were treated with IEP (IFO, VP16, PDD) regimen. The remaining 8 patients with uterine sarcoma (5 cases), squamous-cell carcinoma of the uterine cervix with metastases to the liver or bone (2 cases), and endometrial carcinoma with lung metastases (1 case) were treated with IFO combination chemotherapy. At least two courses of treatment were given unless tumor progression occurred after the first course. RESULTS The overall response rate was 35.3% including 8.8% complete response. The response rate of 26 patients with ovarian cancer was 30.8%. Two patients with PDD-sensitive tumor all achieved complete response, which lasted for one year. The response rate of the remaining 24 PDD-resistant patients was 25% with a mean duration of 5.5 months. There was no complete response. Two patients with cervical carcinoma and two of five patients with uterine sarcoma responded to IFO combination chemotherapy. Relatively severe hematological toxicity was observed, including grade III and IV leucopoenia and thrombocytopenia. Two patients died from severe toxicity. CONCLUSIONS IFO combination chemotherapy is effective in treating recurrent or progressive gynecologic malignancies, especially PDD-sensitive ones. Myelosuppression is relatively severe which may be due to prior long term and intensive chemotherapy.