Objective: To evaluate the efficacy of intravenous (IV) paclitaxel and platinum chemotherapy in patients with high-risk Stage I epithelial ovarian carcinoma. Methods: We performed a retrospective chart review of all patients with Stage I ovarian cancer treated at our institution between March 1993 and June 1995. Results: Twenty patients received adjuvant paclitaxel-containing chemotherapy for Stage I ovarian carcinoma after comprehen­sive surgical staging. Five patients (25%) had Stage IA disease and 15 patients (75%) had Stage IC disease. Tumor grades were: 1, five patients (25%); 2, nine patients (45%); and 3, six patients (30%). Histologic cell types were: clear-cell, ten (50%); endome-trioid, five (25%); mucinous, three (15%); and serous, two (10%). Nineteen patients (95%) were treated with IV paclitaxel and pla­tinum chemotherapy. One patient (5%) received IV paclitaxel alone. Eighteen patients (90%) had five cycles of chemotherapy, while two patients (10%) had three. The 96 total cycles were associated with nine episodes (9%). of significant toxicity: fever, four (4%); severe nausea and vomiting, two (2%); Clostridium difficile enteritis, one (1 %); congestive heart failure, one (1 %); and anemia, requiring blood transfusion, one (1%). With a median follow-up of 36 months (range 24-50 mos), all 20 patients are alive, and 19 (95%) are disease-free. The one patient (5%) treated with IV paclitaxel alone developed an abdominal recurrence 22 months after diagnosis. Conclusion: Primary IV paclitaxel and platinum chemotherapy in patients with high-risk Stage I epithelial ovarian carcinoma is reasonably well tolerated and may improve survival. Larger studies with long-term follow-up are needed.