Objective: The aim of this study was to evaluate the efficacy, adverse reaction and survival of MAID protocol as first-line treatment on 137 metastatic soft tissue sarcomas patients. Methods: One hundredand thirty-seven patients with metastatic soft tissue sarcoma were given MAID protocol chemotherapy which consists of ifosfamide at a total dose of 8-10 g/m2 in 4-5 days, adriamycin at a dose of 60 mg/m2 on first day and dacarbazine at a dose of 200 mg/m2/d in 4-5 days. Twenty one days were regarded as a cycle and 2-6 cycles were completed. The median cycle number was 4. Results: Four cases had complete remission (CR) (2.9%), thirteen cases achieved partial remission (PR) (9.5%), eighty-eight cases maintained a stable disease (SD) (64.2%), and thirty-two cases had progressive disease (PD) (23.4%). The overall response rate (RR) was 12.4%, disease control rate (DCR) was 76.6%. The progression-free survival (PFS) was 2-14 months and median PFS was 5.00 ± 1.12 months. The overall survival (OS) was 3-19 months and median OS was 8.00 ± 1.32 months. Three months PFS rate was 56.9%, six months PFS rate was 27.2% and one year PFS rate was 7.8%. Three months OS rate was 100.0%, six months OS rate was 41.5% and one year OS rate was 10.7%. The main adverse reactions were bone marrow supression, nausea/vomiting and alopecia. Other adverse reactions were seldom observed. Conclusion: The effect of MAID protocol as first-line treatment on metastatic soft tissue sarcomas patients was exact, the treatment can control disease progression effectively and the side effects can be tolerable. It was obviously very worthy in clinical use as one of the first-line chemotherapy protocols on advanced soft tissue sarcomas.