The most usual contemporary approach to the management of the most common presentation of soft tissue sarcomas is a combination radiotherapy and limb-preserving surgery. Local control with this approach exceeds 90% (level 1 evidence). The principles and evidence underpinning this management will be reviewed. A focus on local control while balancing functional outcome and avoiding complications guides the philosophy behind this approach. A landmark trial had shown that pre- and post-operative radiotherapy resulted in similar local control rates. The pre-operative approach uses lower doses (50 Gy versus 66 Gy post-operatively) and treated smaller treatment volumes, with greater sparing of normal adjacent tissues. The primary end-point of this trial was the rate of major wound complications, and there were more wound complications in the pre-operatively irradiated patients (35% pre-operative group versus 17% post-operative group, p=0.01). However longer term follow-up of this trial (2, 3) revealed higher rates of late toxicities, specifically grade 2 fibrosis, edema and joint stiffness, resulting in significant lower function scores. In this review, a summary of the role of radiotherapy (pre- and post-operative) will also address other anatomic, especially retroperitoneal sarcoma for which an important successfully accruing ongoing trial (STRASS) is being conducted in Europe with collaboration of two North American centres. Strategies to reduce the volume of tissue being irradiated in sarcoma in general, as well as the dose of radiotherapy will be mentioned, including the possible omission of radiotherapy entirely in selected cases where it has traditionally been used. For the latter, there is no randomized data to guide indications to omit radiotherapy, but radiotherapy may be avoided if the lesions are “contained” or superficial with intact tissue planes. Finally, more recent developments in radiotherapy will also be discussed including advances through the use of intensity-modulated radiotherapy (IMRT), image-guided IMRT, and potentially even particle therapy.