Arising at a rate of just twenty new cases per year per million people, soft tissue sarcomas remain one the rarest forms of cancer. Fortunately, advances in radiologic imaging, surgery, radiation therapy, and chemotherapy have served to improve local control and overall survival. Work is underway to implement a Northern California regional protocol for the multimodality treatment of children and adults with soft tissue sarcoma. Wide surgical resection and external beam radiation therapy remain the mainstays of treatment. However, high dose rate brachytherapy and intraoperative radiation methods are being used increasingly to apply radiation where it is needed most--- directly to the tumor bed at the time of surgery. For patients younger than 65 with large, deep, high grade tumors, pre-operative or neoadjuvant chemotherapy is also being offered in an attempt not only to treat the tumor itself, but also to decrease the risk of metastatic disease, thereby increasing overall survival.