Bob Duncan started to experience numbness and paralysis on the right side of his face in late 2022 at the age of 75. Concerned, he first talked with his primary care provider. Then, as the symptoms began to affect his ability to blink or track objects with his right eye, he contacted his ophthalmologist. At first, they thought it might be a temporary condition called Bell’s palsy, but the symptoms did not go away.
His brother, an ophthalmologist on the East Coast, urged Duncan to see a specialist. He was worried about a stroke or brain tumor. A resident of Corvallis, Oregon, Duncan went to see a neuro-ophthalmologist in his home state, where he had several scans and two biopsies. There, they discovered that it was neither a stroke nor a brain tumor — it was a type of skin cancer.
He was diagnosed with squamous cell carcinoma with perineural invasion that originated in his right salivary gland. With perineural invasion, cancer grows into the space surrounding a nerve. In Duncan’s case, there was no solid tumor, only dispersed cancerous cells growing along and within his cranial nerves. It’s a very rare condition; only 1-2% of squamous cell carcinomas act this way, and they cannot be addressed surgically. Prognosis is typically very poor, with a very high risk of recurrence despite treatment.
“I was a bit horrified when I got the diagnosis,” Duncan said. “I was especially upset when I learned that radiation was my only option.”
However, Duncan’s brother, who was on the call during the treatment consultation, suggested Duncan receive proton therapy instead of traditional radiation. Duncan had never heard of proton therapy, but he liked what he learned.
A retired Oregon State University oceanography professor, Duncan is a career scientist and researcher at heart. When he was referred to Fred Hutch Cancer Center – Proton Therapy and met with his radiation oncologist, Jay Liao, MD, he was intrigued by the way proton radiation works — that it can be focused to stop at the tumor and spare more healthy tissue from radiation.
“In Mr. Duncan’s case, his tumor invaded the base of the skull and was in a challenging location to treat given how close it was to the brain and eyes. Proton therapy was the optimal approach to effectively target his tumor, while decreasing the risk of serious complications,” Liao said.
Duncan was also able to speak with one of the facility’s medical physicists and get all the deep-dive answers to the technical questions he had, such as how protons are accelerated and what gives them their stopping power.
The RAMPART study results were presented at the 2026 American Society for Clinical Oncology conference earlier this year with hopeful results that showed among the highest rates of event-free survival, progression-free survival and overall survival reported for this patient population (locally advanced, unresectable cutaneous squamous cell carcinoma patients). Researchers are still following patients to determine long-term cancer control outcomes and quality of life.
Liao also suggested that Duncan consider enrolling in a clinical trial that was open at Fred Hutch. The trial was testing whether combining a type of immunotherapy drug called a checkpoint inhibitor both before and after radiation therapy enhances the ability to treat inoperable cancers like Duncan’s. If he opted into the study, he would receive the drug in combination with proton therapy. Being a researcher himself, Duncan joined.
Checkpoint inhibitors work by “unblocking” the cancer cells that have tricked the immune system into ignoring them so that the system will once again attack and hopefully eliminate them. It’s a field that is quickly growing and evolving, with many clinical trials evaluating how to use these therapies to treat more cancers.
In the spring of 2024, Duncan enrolled in the trial and met another patient with a similar squamous cell carcinoma diagnosis who was also receiving proton therapy. That patient was about 30 weeks ahead of Duncan in the trial, so he was able to share his experience with both therapies. Together, they kept each other’s spirits up. Now they are good friends and keep in touch.
Though the immunotherapy treatment would last a year, proton therapy was scheduled for seven weeks, starting in May 2024. During that time, Duncan and his wife explored Seattle and many of its parks. His in-laws also visited and provided a welcome distraction from treatment.
“The whole experience was a little otherworldly,” Duncan said of proton therapy. “The room, the giant machine like something out of a science fiction movie, the mask that kept my head in place for treatment — it took a bit of getting used to, especially because I couldn’t see what was going on, though I did hear mechanical noises.”
He was treated with an advanced form of proton therapy called pencil-beam scanning, which targeted the areas along his cranial nerves, the base of his skull and behind his right eye. He experienced some moderately severe skin irritation at the treatment site, similar to a sunburn, according to Duncan, which cleared up after the treatment ended. His skin was very fragile during and right after treatment. His care team had him protect it with a variety of lotions they prescribed, and he was told to avoid the sun.
He’s had some lingering effects to his right ear, including some hearing loss and lymphedema (slower lymph drainage), and his beard no longer grows on the right side of his face. His facial paralysis is mostly gone now, except that he still can’t move his right eye perfectly and blinking takes effort, which is likely related to some nerve damage from the original tumor, Liao said. He keeps it taped closed most of the time and wears an eyepatch outside. Overall, he’s feeling normal and is cautiously optimistic.
Fortunately, Duncan has been without any evidence of cancer progression and his follow-up imaging looks clear.
Now, Duncan is planning fun things to do in life, including another trip to Seattle — this one for the men’s World Cup with his son and daughter-in-law. Duncan played and coached soccer for many years and his son has made it a career. They’re rooting for both the U.S. and Australia, as both Duncan and his wife were born there.
As Duncan settles back into doing the things he loves, he has encouragement for other patients.
“I am amazed at how quickly cancer treatment is evolving,” Duncan said. “Options used to be limited, but now there are so many. It shows we’re successful in treating cancer. Ask about clinical trials because that’s where progress is made.”
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