The use of chemotherapy in the treatment of patients with advanced soft tissue sarcoma and as adjuvant and neoadjuvant therapy is reviewed. In advanced disease a response rate of up to 35% can be achieved with combination chemotherapy, but these are mainly partial remissions; few complete remissions are attained. The median survival for patients in partial remission is 2 years. The most active cytotoxic drug is adriamycin, with a remission rate of 30%. The addition of dacarbazine can increase the remission rate; however, this has no significant impact on survival and the toxicity is more pronounced. The activity of neoadjuvant or adjuvant chemotherapy is still controversial. Some studies indicate a positive effect on disease-free or overall survival with adriamycin-containing regimens. Other studies have not confirmed these results. More controlled trials with adequate numbers of patients stratified for tumor subtype, tumor localization and grading are needed to define the value of adjuvant or neoadjuvant chemotherapy in soft tissue sarcomas. Optimal interdisciplinary treatment can only be realized at specialized centers.