OBJECTIVES To assess and compare the efficacy and toxicity of radiotherapy (RT) versus chemotherapy (CT) in patients with nodal and isolated nonnodal recurrence of ovarian cancer. METHODS Records of 67 patients treated for nodal or isolated nonnodal ovarian cancer recurrence (50 treated with RT and 17 treated with CT) between 2001 and 2010 were retrospectively reviewed. Patients' responses to RT and CT were assessed by the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to the National Cancer Institute Common Toxicity Criteria, version 3.0. Progression-free survival and overall survival were calculated using the Kaplan-Meier method. RESULTS The overall response rate was 64.0% in the RT group and 16.7% in the CT group (P = 0.003). The median follow-up time was 38 months (range, 3-97 months) for RT and 18 months (range, 70-64 months) for CT. The median progression-free survival was 6 months for radiotherapy and 5 months for chemotherapy (P = 0.212). Median overall survival between the 2 groups was not significantly different (P = 0.246). There was no RT-mediated grade 3 or 4 hematologic toxicity, but overall toxicity was not significantly different between the 2 groups. CONCLUSIONS Radiotherapy resulted in a better response and tolerable toxicities compared to CT in patients with either nodal or isolated nonnodal ovarian cancer recurrence. However, progression-free survival and overall survival did not differ between RT and CT. A prospective, multicenter, randomized controlled study is needed to evaluate the survival benefits of RT for ovarian cancer.