Abstract: Tumor-associated macrophages (TAMs) are closely involved in the initiation, progression, metastasis and recurrence of tumors. According to different phenotypes and functions, TAMs can be classified as M1-like type or M2-like type, mainly related to anti-tumor immunity and tumor promotion, respectively. Radiotherapy is one of the main treatments for most solid tumors, which can directly kill tumor cells and indirectly affect tumor microenvironment (including TAMs), thus regulating macrophages to radiotherapy-resistant or radiotherapy-sensitive phenotype, which in turn affects the efficacy of radiotherapy. Targeting TAMs to inhibit the tumor-promoting effect and promoting the repolarization of TAMs to M1-like type have become promising methods of cancer therapy. The combination of targeting TAMs and radiotherapy can synergistically inhibit tumor progression, improve the therapeutic effect and reduce radiotherapy resistance. In this review, the authors discuss the current understanding of the role and interaction mechanism of TAMs in tumor radiotherapy, and the latest progression in the combination therapy of targeting TAMs and radiotherapy.