Chemotherapy is the prerequisite and foundation of limb-preserving therapy, and only a few new chemotherapeutic agents have been introduced since the 1970s, with clinical trials leading to continuous improvement in treatment efficacy. Research in the past decades has focused on the combination of chemotherapeutic drugs, the use of chemotherapeutic drugs by different routes of administration, and increasing the dose of administration. To determine the chemotherapy regimen, the histological grading and staging of the tumor should be clarified first. Tumors with few distant metastases are generally less likely to be treated with systemic chemotherapy. Among bone and soft tissue tumors, osteosarcoma is one of the few tumors for which adjuvant chemotherapy has a definite effect. The chemotherapy regimen for Ewing sarcoma is largely established. The role of systemic chemotherapy in other soft tissue sarcomas is not definitive. However, when soft tissue sarcomas develop metastases, systemic chemotherapy, mainly adriamycin, is generally given. Neoadjuvant chemotherapy (also known as induction chemotherapy and preoperative chemotherapy) is chemotherapy administered before surgical resection of the tumor after a clear diagnosis on biopsy.9 In 1982, Rosen9 proposed the principles of neoadjuvant chemotherapy, which mainly include preoperative high-dose application of chemotherapy and determination of tumor necrosis rate: the purpose of preoperative high-dose chemotherapy is to administer early systemic The purpose of preoperative high-dose chemotherapy is to provide early systemic chemotherapy to eliminate microscopic metastases in the lung and improve patient survival; after chemotherapy, the primary tumor necrosis and volume reduction provide a safer surgical border for limb-preserving surgery, thus improving limb preservation rate and reducing recurrence rate. It also allows the use of the preoperative chemotherapy period for prosthesis design and fabrication. Determine the rate of necrosis after tumor resection (Huvos classification) and decide the postoperative chemotherapy regimen based on the rate of necrosis.10 Provisor et al.10 reported that for cases with >95% tumor necrosis and a good histologic response, CCG782 was used to maintain regimen B for three courses with HDMITX, VCR, BCD, DOX. After years of clinical practice, Rosen’s neoadjuvant chemotherapy principles have proven to be effective, with 5-year survival rates of more than 80% and 85% limb preservation rates in patients with osteosarcoma. Induction chemotherapy is also currently being used in the treatment of some soft tissue sarcomas, but the efficacy remains to be clarified. Interventional chemotherapy is considered to be a localized chemotherapy in which high concentrations of chemotherapeutic drugs can enter the tumor cells directly by diffusion and exert cytotoxic effects on the tumor directly in the original form of drug molecules (without liver inactivation). It has lower side effects than systemic chemotherapy, shortens the dosing interval, and helps to enhance the killing effect on tumor cells. It increases the intensity of local drug dose while decreasing the distribution of drugs in normal tissues, and domestic research14 and clinical applications have been conducted in this area. Interventional chemotherapy includes local arterial perfusion chemotherapy, arterial embolization chemotherapy, and subcutaneous implantation arterial chemotherapy. In the past decades, many studies have focused on whether increasing the intensity of drug dose therapy can improve the efficacy of chemotherapy. This is because it has been argued that there is a dose-effect curve for chemotherapy and therefore increasing the intensity of treatment will kill more tumor cells and potentially improve treatment success. One of the most important advances in chemotherapy-supported therapy is the use of colony cell stimulating factors. Rescuing by autologous stem cell transplantation can further increase the intensity of treatment. It is not clear which is more important for efficacy, the total dose or the fractionated dose intensity in chemotherapy for bone and soft tissue conventional tumors. The limited progress in chemotherapy for tumors of the skeletal muscle system over the past 5 to 10 years suggests that the efficacy achieved by increasing the intensity of therapy has reached its limits and that new therapeutic approaches may need to be investigated to achieve better chemotherapy outcomes. Targeted Approaches is an emerging concept of drug therapy. Previously used chemotherapeutic drugs were not specific and acted by damaging the DNA of all cells, while most antitumor drugs developed under the concept of molecular targeting act specifically on the abnormal molecular pathways of tumor cells, thus killing them more specifically and effectively.