Objective: To investigate the clinical value and application of ATP based bioluminescence tumor chemo-sensitivity assay (ATP-TCA) in the chemotherapy for ascites caused by recurrent ovarian cancer. Methods: More than 10 kinds of chemotherapeutic drugs or combinations were applied and 35 ascites specimens from recurrent ovarian cancer were analyzed by ATP-TCA. Sensitivity of chemotherapeutic drugs was assessed. After 2-4 chemotherapeutic cycles, clinical outcomes were analyzed, which were compared with those of 40 cases by empirical regimens. Results: 32 of 35 specimens were evaluated with an overall evaluation rate of 91%. The assay results suggested that chemo-naive patients responded to chemotherapeutic drugs with individualized profiles. The sensitivity rates of GEM, EPI, OXA, DDP, CBP, ADM, VP-16, CTX, NVB, 5-FU, PTX and TXT were 40%, 30%, 33%, 29%, 33%, 38%, 25%, 33%, 38%, 33%, 25% and 20%, respectively. While the sensitivity rates of combinations GEM + EPI, GEM + CBP, GEM + DDP, NVB + DDP, CTX + ADM + DDP, CTX + ADM, DDP + VP-16, OXA + 5-FU, VP-16 + IFO, PTX + DDP, TXT + CBP, VCR + CTX + MTX, DDP + CPT-11, OXA + CPT-11, and DTIC + CTX were 47%, 50%, 36%, 44%, 30%, 33%, 27%, 33%, 40%, 27%, 23%, 14%, 28%, 30% and 17%, respectively. In vitro results correlated well with clinical outcomes. Objective response rate (RR) in chemo-sensitivity-guided group was of significance compared with that in empirical-regimen-guided group. Conclusion: ATP-TCA is a choice for the screening of chemotherapeutic drugs against ascites caused by recurrent ovarian cancer with excellent sensitivity and reliability. ATP-TCA assay results correlate well with clinical outcomes, suggesting its clinical value in the management of difficult-to-manage therapeutic situations such as ascites in recurrent ovarian cancer. Objective: To investigate the clinical value and application of ATP based bioluminescence tumor chemo-sensitivity assay (ATP-TCA) in the chemotherapy for ascites caused by recurrent ovarian cancer. Methods: More than 10 kinds of chemotherapeutic drugs or combinations were applied and 35 ascites specimens from recurrent ovarian cancer were analyzed by ATP-TCA. Sensitivity of chemotherapeutic drugs was assessed. After 2-4 chemotherapeutic cycles, clinical outcomes were analyzed, which were compared with those of 40 cases by empirical regimens. Results: 32 of 35 specimens were The sensitivity results of GEM, EPI, OXA, DDP, CBP, ADM, VP-16, CTX, NVB While 5-FU, PTX and TXT were 40%, 30%, 33%, 29%, 33%, 38%, 25%, 33%, 38%, 33%, 25% and 20% rates of combinations GEM + EPI, GEM + CBP, GEM + DDP, CTX + ADM, DDP + VP-16, OXA + 5-FU, VP-16 + IFO, PTX + DDP, TXT + CBP, VCR + CTX + MTX, DDP + CPT- 11, OXA + CPT-11, and DTIC + CTX were 47%, 50%, 36%, 44%, 30%, 33%, 27%, 33%, 40%, 27%, 23%, 14%, 28 Objective response rate (RR) in chemo-sensitivity-guided group was of significance compared with that in empirical-regimen-guided group. Conclusion: ATP- TCA is a choice for the screening of chemotherapeutic drugs against ascites caused by recurrent ovarian cancer with excellent sensitivity and reliability. ATP-TCA assay results correlate well with clinical outcomes, suggesting its clinical value in the management of difficult-to-manageability situations such as ascites in recurrent ovarian cancer.