The purpose of this study was to update the experience and demonstrate the effectiveness and limitations of 241 Am applicators for previously irradiated patients and for selected patients with primary gynecologic malignancies. Between October 1986 and May 1994, 30 patients were treated with 241 Am. The median patient age was 68 years, ranging from 41 to 91 years. Patients were retrospectively categorized by treatment intent, i.e., palliative vs. curative. Patients undergoing curative therapy were further classified as to whether 241 Am brachytherapy was directed at microscopic residua after surgery or to gross primary tumor. Of the 30 patients, 18 had recurrent pelvic malignancies from various primary sites and were reirradiated with 241 Am for palliation. Six patients had microscopic disease after surgical resection and were managed with postoperative radiotherapy (RT) that included 241 Am. Six patients had gynecologic cancers managed with primary RT that included treatment with 241 Am. Overall, 50% (9/18) of the patients with recurrent pelvic malignancies were locally controlled after reirradiation with 241 Am. Including surgical salvage, the ultimate local control rate was 61% (11/18). Postoperative 241 Am with or without external beam radiation therapy (XRT) was effective in 83% (5/6) of the patients with microscopic disease. Including surgical salvage, 100% (6/6) of the patients were ultimately free of disease. Fifty percent (3/6) of the patients treated with primary RT that included 241 Am brachytherapy experienced local control. Including surgical salvage, 67% (4/6) of the patients were ultimately controlled with 241 Am. In conclusion, reirradiation utilizing 241 Am was effective in palliating patients with recurrent pelvic malignancies. 241 Am was effective in 83% (5/6) of the patients with microscopic disease managed with postoperative RT. 241 Am was of marginal benefit in patients with gynecologic tumors managed with primary RT.