Purpose: Patients with gynecologic malignancy are often treated with definitive or adjuvant radiotherapy as part of their initial therapy. When such patients have a local recurrence or develop a new gynecologic primary, choice of management strategy is often a dilemma due to the risks of reirradiation versus the risks of surgery in light of patient comorbidities, technical factors, or the necessity for a radical resection. A retrospective review of institutional experience with reirradiation was performed to determine the effectiveness and morbidity of such treatment. Materials and Methods: Twenty-four patients were reirradiated for locally recurrent or new primary gynecologic cancers at Wake Forest University from 1987-2004. All patients had received prior teletherapy and/or brachytherapy for definitive or adjuvant treatment or as therapy for recurrence of a gynecologic malignancy not previously treated with radiotherapy. Initial primary sites were uterine (15), cervical (7), or vaginal (2). 21 patients were treated for recurrences, while 3 patients were treated for new primaries. Initial radiation treatments were teletherapy alone (8), brachytherapy alone (2), or both teletherapy and brachytherapy (14). The interval between completion of the initial radiation treatment and new diagnosis was <1 year in 5, 1-3 years in 7, 3-10 years in 5, and 10+ years in 7 with an overall median of 2.6 years and a range of 0.5-36 years. Secondary radiation treatments were brachytherapy alone (16), teletherapy alone (1), or both (7). Secondary brachytherapy treatments included iridium templates (15), gold seeds (6), and intracavitary cesium (2). Kaplan-Meier curves were generated to estimate local control, distant metastasis-free survival, disease-free survival, overall survival, and the development of grade 3-4 toxicity from the time of completion of reirradiation. Grade 3-5 toxicities were recorded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.02. Results: All patients derived significant regression of disease and palliation of symptoms with reirradiation. Local control rates at 2 and 5 years were 64% and 57%, respectively, with failure occurring at a median time of 11.0 months in the 9 patients who failed locally. Distant metastasis-free survival rates at 2 and 5 years were 66% and 52%, respectively, with failure occurring at a median time of 1.4 years in the 10 patients that did fail distantly. The first sites of distant failure were the lung (4), liver (2), mediastinal lymph nodes (1), pelvic lymph nodes (1), retroperitoneum (1), and bone (1). Disease-free survival rates at 2 and 5 years were 39% and 28%, respectively, with a median of 1.4 years. Overall survival rates at 2 and 5 years were 71% and 46%, respectively, with a median of 4.0 years. Grade 3-4 toxicity at 2 and 5 years was 14% and 22%, respectively, with occurrence at a median time of 10.8 months in the 4 patients experiencing such toxicity. Adverse grade 3 events included vaginal necrosis in one patient, rectovaginal and enterovesicular fistulas requiring surgical repair in one patient, and vaginal hemorrhage requiring hospitalization in one patient. Adverse grade 4 events included vaginal necrosis requiring hyperbaric oxygen treatments in one patient. No patient experienced a grade 5 treatment-related toxicity. Conclusions: Our institutional experience with reirradiation for recurrent or new primary gynecologic malignancy with an emphasis on brachytherapy shows that such treatment is associated with disease regression and symptom palliation in all patients with more than half achieving durable local control with an acceptable rate of toxicity.