Myositis ossificans (MO) is a rare disorder of ectopic ossification in soft tissue or muscle, usually associated with trauma or hereditary conditions. Surgical excision is the mainstay of treatment with anti-inflammatory medications. Radiotherapy is used as an adjuvant therapy, to treat residual lesions and to relieve symptoms.

A 36-year-old male presented with a localised tender swelling in left popliteal fossa and progressive pain in lower limb for 6 weeks and restricted mobility for 3 weeks. A local excision of calcified mass arising from fascia of left popliteal fossa was consistent with MO features. Due to persistent symptoms and a residual lesion on imaging, adjuvant external beam radiation therapy (EBRT) was planned with a low dose of 10 Gy (Gray) in 2 fractions on 2 consecutive days in a prone position after 2 weeks using 6 MV (mega voltage) photon beam on linear accelerator (LINAC).

Radiotherapy resulted in a significant clinical improvement without any related acute toxicities. Patient is disease-free and on regular follow-up without any progression after 2 years.

Post-operative EBRT can stabilise residual MO and treat intractable pain when lesion lies in the vicinity of a neurovascular bundle

Buschke–Lowenstein tumour (BLT) is a rare verrucous lesion often associated with human papillomavirus infection. It is an indolent but locally aggressive lesion usually arising from the genitalia or anorectum, with a potential risk of recurrence and malignant transformation. The first line of management is surgical or laser excision. Topical agents cryotherapy, radiotherapy and chemo-immunomodulators are reserved for residual or recurrent cases and smaller lesions.

A 24-year-old female on antiretroviral therapy presented in our department with a large cauliflower-shaped growth involving the perineum, vulva and lower vagina. A biopsy of the lesion was suggestive of a BLT. Due to the extensive nature of the disease, surgery was deferred. The lesion was treated with definitive external beam radiation therapy (EBRT) using a 6-megavoltage photon beam on a Cobalt-60 unit.

Radiotherapy resulted in a significant response without any acute toxicity, following which, topical podophyllin application was advised for the residual perianal lesion. The patient is disease free after 9 months of follow-up.

A multidisciplinary approach is important to treat the BLT. Lesions not amenable to surgery or local therapies can be treated with EBRT with reasonable control and acceptable toxicities.