In Reply

We welcome the comments from Oertel et al as a welcome addition to our article. They highlight additional therapeutic options in the treatment of previously operated pituitary adenomas, which we could not include in any detail in our article owing to space restrictions (1). The comments regarding radiotherapy for pituitary adenomas are consistent with the details and recommendations given in the clinical practice guideline entitled “Diagnostik und Therapie klinisch hormoninaktiver Hypophysentumoren [the diagnosis and treatment of clinically endocrine inactive pituitary tumors]” issued by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) (2). Single stereotactic radiosurgery and (hypo)fractionated radiotherapy have their place in treating pituitary adenomas, depending on the respective size and contour of the postoperative residual tumor and its relation to the anterior visual pathway. The advantages of radiosurgery over fractionated radiotherapy in endocrine active tumors—for example, in acromegaly—are the tendentially faster effect on the hypersecretion syndrome and the significantly lower rate of secondary pituitary dysfunction (3), when—as Oertel and colleagues correctly pointed out—much higher dosages have to be administered than for endocrine inactive tumors. For this reason, the initially interdisciplinary approach makes sense—namely, to undertake individually tailored partial tumor resection in order to enable radiosurgical treatment—in treating pituitary adenomas that are not completely resectable. Under the label “separation surgery” this has also been proposed for treating vertebral body metastases (4). We agree with our correspondents that therapeutic decisions in this tumor entity too should be made in the setting of interdisciplinary tumor boards (2).