There is a recurrence of disease. The treatment option depends on what treatment he has taken yet. Surgery won't be possible ( however a surgeon's opinion is a must). Radiotherapy is a option if not taken earlier or if > 2 years from last radiotherapy. If both cannot be done the the next option is Chemotherapy / Chemotherapy + immunotherapy/ metronomic therapy based on patients general condition. If patient is very low general condition then best supportive care is also a option. If he already on treatment for disease recurrence, since there is progressive disease treatment should be changed if possible. However I would suggest to do PETCT for comparison and proper evaluation of disease progression (as it was done previously also)