We investigated the efficacy of preoperative hyperthermia combined with radiation therapy and systemic chemotherapy (hyperthermochemoradiotherapy; HCRT) as a multimodality limb-sparing approach for soft tissue sarcomas. From January 1991 to December 1994, HCRT was performed in 13 patients with soft tissue sarcomas at our institute. Hyperthermia, with an intratumoral temperature of ≥42.0°C, was given for 1 h for a total of eight to ten times. Radiation therapy (30–40 Gy) was given at 200 cGy per fraction. Two cycles of chemotherapy were given before surgery. It took 4–5 weeks to accomplish the HCRT, and surgery was performed 3 weeks later. Partial response (PR) was achieved in 3 patients and no change (NC) was shown in 10. The mean reduction of tumor volume was 20.2%. Pathological examination of the resected specimen revealed 10%–100% tumor necrosis (mean 76.4%). There was no correlation between histologic response and reduction of tumor volume. Limb-sparing surgery was feasible in 12 patients (92.3%) and the final limb salvage rate was 84.6%. No local recurrence was observed during a mean follow-up time of 25 months. Four patients developed distant metastases and 2 patients died of the disease. The results of this study indicate that HCRT is an effective treatment for limb-threatening soft tissue sarcomas.