Radiation therapy combined with conservative surgical resection has been shown to be an effective method of producing local control in patients with soft tissue sarcomas. In 170 patients treated with this combination at the Massachusetts General Hospital (MGH) the 5-year actuarial local control rate was 84% and the 5-year survival rate 69%. For tumors in the extremity, treatment resulted in limbs with normal or near-normal function. The combination of preoperative irradiation to doses of approximately 5000 cGy, followed by local resection and an additional dose of 1400 cGy, delivered either intraoperatively or postoperatively, has theoretical advantages in terms of decreasing tumor implantation, facilitating a conservative surgical resection, and assuring full cooperation between the various physicians. Sixty patients have been treated with this approach at the MGH with good local control and without major problems with wound healing. When surgical resection is not performed, radiation therapy alone can produce local control and survival in 44% and 28% of patients, respectively.