What is the preferred regimen for testicular lymphoma with de novo symptomatic CNS involvement and systemic disease at the time of presentation ?   

I often consider treating with high dose methotrexate alternating with R-CHOP in such cases. At the end of treatment, I consider radiation to the contralateral testicle. Others have treated similar patients with Hyper-CVAD (Park et al. Am J Hematology 2007)