Chemotherapy for recurrent ovarian carcinoma (ROC) produces response rates of 10-80% depending on the prevalence of platinum resistance. Most patients relapse within 1 year and median progression-free survival is generally no more than 6 months. Newly developed ATP chemosensitivity assays (ATP-TCA) offer the opportunity for individualized therapy and have shown promising results compared to standard regimens. We report on an unusual case of long-term survival in a patient with stage III c ovarian cancer failing postoperative platinum-based high-dose treatment who subsequently underwent repeated chemotherapy over a period of 4 years. The chemotherapy protocol was selected by pretherapeutic ex vivo ATP-based chemosensitivity testing of autologous tumor tissue. To our knowledge, this is one of the few cases of ROC in which partial remissions using conventionally dosed chemotherapy were achieved repeatedly despite a unfavorable relapse-free interval after high-dose chemotherapy for primary disease. We conclude that ATP-TCA-directed chemotherapy for ROC can select active and tolerable regimens even in difficult therapeutic situations in which no standards recommendation exists.