Surgery is the first line of treatment. For some people it is all that is required and there is no recurrence. No one is clear why, when there has been good surgery with clear margins round any excised lump, the disease then spreads in some people and doesn't in others. 

Experienced sarcoma oncologists do not generally follow-up good surgery for LMS with either radiation or chemotherapy although some other sarcomas are treated differently. Statistically over a long period of time there is no evidence that post-operative chemotherapy offers any benefits to LMS patients. Radiation will be used if the margins round surgery are not clear.  It is not unknown for a cancer consultant at a general hospital to talk of following up surgery with chemotherapy and if this is proposed to an LMS patient careful research and questioning should be undertaken before agreeing. This is definitely a point where a second opinion from a sarcoma unit should be sought.

So, after good first surgery, it's get on with life if you can.     

Recurrence will be treated with surgery again if possible. Distant metastasis, which is usually to the lungs or liver, can only be spotted by CT scans. Follow up by CT scanning every 3 months is common in the US,  but in the UK it seems to be six monthly with intermediate chest x-rays.  You might have to push to be scanned in the absence of any other evidence of disease. UK sarcoma specialists have an interest in maintaining what they call "quality of life". Scans are a source of anxiety while waiting for the appointment and then for the results but that is not a reason for less frequent scanning - there are not enough scanners or radiographers in the UK.

Chemotherapy comes into play as the primary treatment with inoperable tumours and may be a first line of treatment of choice in the case of lung tumours. The two drugs most frequently used are Doxorubicin and Ifosfamide. Both are amongst the strongest chemo drugs available . A course is usually 6 cycles, three weeks apart - with a review after two cycles to see whether any impact is being made. Its not an enjoyable experience but it doesn't hurt.

New drugs are coming into the standard treatment regimes during 2001/02. They will include new chemotherapy treatments (some of which are now being widely used in the USA) although because the drugs (such as Doxil and the taxanes) are costly it is likely they will be second-line treatments only used if the standard drugs have no impact.
