The aims of this study were to investigate the efficacy and safety of radiotherapy combined with temozolomide (TMZ) after glioma resection. A total of 86 patients with glioma were randomly divided into two groups (n=43). Group A was treated with 3D conformal radiotherapy combined with TMZ (RTMZ), and Group B was only treated with 3D conformal radiotherapy. The clinical efficacy, postoperative 1, 2 and 3-year survival rate, Karnofsky score, and side effects were compared and analysed. The objective response rate (ORR) and disease control rate (DCR) values in group A were 76.7% and 90.7% respectively, significantly higher than group B (55.8% and 74.4%, P<0.05). The Karnofsky scores of both groups were improved after treatment than before (P<0.05). The median survival period and postoperative 1, 2 and 3-year survival rates in group A were significantly higher than group B (P<0.05). There was no significant difference in the side effects between the two groups (P>0.05). R-TMZ is a safe and effective adjuvant therapy after glioma resection, which can improve short-term and long-term survival rate while not increase side effects.