The outcomes in 32 cases of histologically diagnosed primary central nervous system lymphoma were investigated. The 1-, 2-, and 5-year survival rates were 54, 36, and 8%, respectively. Good outcome was indicated by extensive surgical removal with 50-Gy irradiation and lower ages. 61% of patients receiving radiation therapy suffered recurrence within 1 year. The incidence of multiple lesions increased at recurrence. These lesions were almost all remote from the initial site in the brain, occurring more frequently in the central part of the supratentorial regions near the ventricle. Multiple lesions recurred more rapidly than single lesions. Longer survival times were indicated by a long tumor-free period after initial treatment. Extensive surgical removal results in long survival times for patients with a localized single tumor in the early stage. Radiochemotherapy should be given as part of the initial treatment.