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 addressed...

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.

I would probably cycle back to Taxol and carboplatin, followed by a different hormonal treatment. An AI, for instance.