Stage IVB includes: (T4b, Any N, M0); (Any T, N3, M0). T4b: Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve, nasopharynx, or clivus. N3: Metastasis in a lymph node, more than 6 cm in greatest dimension. M0: No distant metastasis. (AJCC 7th ed.) [from NCI]