After an optimal tertiary cytoreduction for recurrent granulosa cell tumor previously treated with BEP and hormonal therapy, would you recommend systemic chemotherapy?  

Yes, I would give adjuvant therapy. I would go with carbo taxol. The MD Anderson people have been using this regimen for some time. It is less toxic and appears to be as active as BEP. I think Jubilee Brown published a paper on this subject recently. This exact meeting was not specifically address...

If it was R0 with no residual disease, then - no - I would not treat. If there was some disease left (even if optimal) - I would consider chemo - Carbo/taxol - not BEP. Observation is also very reasonable in order to reserve further systemic chemo for when the disease is no longer resectable. ...