Objective To assess the clinical efficacy, safety and cost-effectiveness of topotecan for recurrent epithelial ovarian cancer. Methods We searched MEDLINE (1966 to 2005), EMbase (1989 to 2004), CancerLit (1996 to 2003), CBMdisc (1978 to 2005), CNKI (1994 to 2005), The Cochrane Library (Issue 3, 2005), The National Research Register, and the Health Technology Assessment Database (HTA). Relevant journals were also handsearched. The search was conducted on December 31, 2005. Randomize controlled trials (RCTs) comparing topotecan versus other agents for recurrent epithelial ovarian cancer were included. The quality of the eligible trials was assessed by two reviewers independently. Meta-analysis was performed. Results Four RCTs met the inclusion criteria, and the methodological quality was either level A or B. When used as second-line chemotherapy for recurrent ovarian cancer, there was no significant difference in remission rate between topotecan and paclitaxel or pegylated liposomal doxorubicin (PLD). The clinical benefit rate of topotecan was higher than that of paclitaxel or PLD. Myelosuppression was more frequent in patients in the topotecan group than those in the PLD or paclitaxel group, but it was not severe. As to cost-effectiveness analysis, topotecan was better than PLD. Conclusions The standard regimen of topotecan (intravenous 1.5 mg/m2/d for 5 consecutive days) is recommended for use in platinum-resistant and refractory ovarian cancer.